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Postoperative adjuvant chemotherapy versus chemoradiotherapy for node-positive esophageal squamous cell carcinoma: a propensity score-matched analysis.

ABSTRACT: BACKGROUND AND PURPOSE:After esophagectomy, adjuvant chemotherapy (S?+?CT) and adjuvant chemoradiotherapy (S?+?CRT) can improve survival in patients with node-positive resectable esophageal cancer. However, we are not aware of any studies that directly compared these adjuvant treatments. This study aimed to compare S?+?CT and S?+?CRT for patients with esophageal cancer. MATERIALS AND METHODS:We retrospectively identified patients with node-positive esophageal squamous cell carcinoma who underwent S?+?CT or S?+?CRT at Sichuan Cancer Hospital during 2008-2017. The patients' characteristics were compared, as well as their overall survival (OS) and disease-free survival (DFS) outcomes. Propensity score matching was used to create balanced patient groups according to adjuvant treatment, and a Cox proportional hazards model was used to identify factors that predicted the survival outcomes. RESULTS:The 859 eligible patients underwent S?+?CRT (250 patients, 29.1%) or S?+?CT (609 patients, 70.9%). After propensity score matching (247 patients per group), the 5-year OS rates were 41.8% for S?+?CRT and 26.8% for S?+?CT (p?=?0.028), and the 5-year DFS rates were 37.2% for S?+?CRT and 25.5% for S?+?CT (p?=?0.012). Multivariate Cox regression analysis of the matched samples revealed that, relative to the S?+?CT group, the S?+?CRT group had better OS (hazard ratio: 0.71, 95% CI: 0.56-0.91; p?=?0.006) and DFS (hazard ratio: 0.70, 95% CI: 0.56-0.88; p?=?0.002). CONCLUSION:Among patients with node-positive resectable esophageal squamous cell carcinoma, S?+?CRT was associated with better OS than S?+?CT. A multicenter randomized clinical trial is warranted to confirm these findings.

SUBMITTER: Wang Q

PROVIDER: S-EPMC7245784 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Postoperative adjuvant chemotherapy versus chemoradiotherapy for node-positive esophageal squamous cell carcinoma: a propensity score-matched analysis.

Wang Qifeng Q Lang Jinyi J Li Tao T Peng Lin L Dai Wei W Jiang Yinchun Y Xie Tianpeng T Fang Qiang Q Wang Yi Y Wu Lei L Cao Bangrong B Han Yongtao Y

Radiation oncology (London, England) 20200524 1

<h4>Background and purpose</h4>After esophagectomy, adjuvant chemotherapy (S + CT) and adjuvant chemoradiotherapy (S + CRT) can improve survival in patients with node-positive resectable esophageal cancer. However, we are not aware of any studies that directly compared these adjuvant treatments. This study aimed to compare S + CT and S + CRT for patients with esophageal cancer.<h4>Materials and methods</h4>We retrospectively identified patients with node-positive esophageal squamous cell carcino ...[more]

PMID: 32448253

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Project description:ImportanceDistant recurrence following preoperative chemoradiotherapy and resection in patients with gastroesophageal adenocarcinoma is common. Adjuvant chemotherapy may improve survival.ObjectiveTo compare adjuvant chemotherapy with postoperative observation following preoperative chemoradiotherapy and resection in patients with gastroesophageal adenocarcinoma.Design, setting, and participantsPropensity score-matched analysis using the National Cancer Database. We included adult patients who received a diagnosis between 2006 and 2013 of clinical stage T1N1-3M0 or T2-4N0-3M0 adenocarcinoma of the distal esophagus or gastric cardia who were treated with preoperative chemoradiotherapy and curative-intent resection. Patients receiving adjuvant chemotherapy were matched by propensity score to patients undergoing postoperative observation.ExposuresAdjuvant chemotherapy and postoperative observation.Main outcomes and measuresOverall survival.ResultsWe identified 10 086 patients (8840 [88%] male; mean [SD] age, 61 [9.5] years), 9272 in the postoperative observation group and 814 in the adjuvant chemotherapy group. Patients receiving adjuvant chemotherapy were younger (18-54 years: 252 [31%] vs 1989 [21%]; P < .001) and were more likely to have advanced disease (ypT3/4: 458 [62%] vs 3531 [46%]; P < .001; ypN+: 572 [72%] vs 3428 [39%]; P < .001), as well as shorter postoperative inpatient stays (>2 weeks: 94 [13%] vs 1589 [20%]; P < .001). A total of 732 patients in the adjuvant chemotherapy group were matched by propensity score to 3660 patients in the postoperative observation group. Adjuvant chemotherapy was associated with improved overall survival compared with postoperative observation (median survival: 40 months; 95% CI, 36-46 months vs 34 months; 95% CI, 32-35 months; stratified log-rank P < .001; hazard ratio, 0.79; 95% CI, 0.72-0.88). Overall survival at 1, 3, and 5 years was 88%, 47%, and 34% in the observation group, and 94%, 54%, and 38% in the adjuvant chemotherapy group, respectively. Adjuvant chemotherapy was associated with a survival benefit compared with postoperative observation in most patient subgroups.Conclusions and relevanceFor patients with locally advanced gastroesophageal adenocarcinoma treated with preoperative chemoradiotherapy and resection, adjuvant chemotherapy was associated with improved overall survival. Our findings have important implications for the postoperative treatment of this patient group for which few data are available.

Project description:BackgroundAt present, the primary treatment of esophageal cancer is surgery-based comprehensive treatment, including adjuvant therapy such as chemotherapy and/or radiotherapy. However, the role of adjuvant therapy for esophageal squamous cell carcinoma (ESCC) with pathologically node-negative (pN0) disease is controversial. This study aimed to evaluate the impact of postoperative adjuvant therapy on survival in patients with pN0 ESCC.MethodsPatients with ESCC who underwent R0 esophagectomy in the Department of Thoracic Surgery of Sichuan Cancer Hospital from January 2008 to December 2013 were enrolled. Patients were divided into two groups: a surgery alone (Group S) group or a surgery + adjuvant therapy (Group S + A) group. The primary outcomes were overall survival (OS) and disease-free survival (DFS), and every consecutive case was followed up until death or the last follow-up.ResultsA total of 387 patients with ESCC patients who had pN0 were enrolled in the study. After propensity score matching (PSM), each group consisted of 150 patients. In the overall cohort, the 5-year OS (75.6% vs. 69.7%; P=0.004) and 5-year DFS (64.9% vs. 48.2%; P=0.003) rates were higher in Group S + A than in Group S. In the matched samples, the same outcomes were observed (5-year OS: 75.6% vs. 69.7%, P=0.026; 5-year DFS: 67.6% vs. 69.6%, P=0.036). Multivariate regression analysis indicated that postoperative chemotherapy was associated with longer OS [hazard ratio (HR): 0.622, 95% confidence interval (CI): 0.416-0.928; P=0.02] and DFS (HR: 0.571, 95% CI: 0.390-0.836; P=0.004); in contrast, T3 stage tumors (HR: 1.953, 95% CI: 1.238-3.082; P=0.004) and <15 lymph node dissections (HR: 1.81; 95% CI: 1.238-2.648; P = 0.002) were found to be independent risk factors for pN0 ESCC.ConclusionsAdjuvant therapy, especially chemotherapy, prolonged OS and DFS for patients with ESCC who had pN0 disease. Fewer lymph node dissections and T3 stage tumors were independent risk factors for OS and DFS.

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Postoperative adjuvant chemotherapy versus chemoradiotherapy for node-positive esophageal squamous cell carcinoma: a propensity score-matched analysis.

Publications

Postoperative adjuvant chemotherapy versus chemoradiotherapy for node-positive esophageal squamous cell carcinoma: a propensity score-matched analysis.

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